AMA Guides® Newsletter - Issue Archive

Articles

1. Employability

   Alan Engelberg

   Pages 1–2

   DOI: 10.1001/amaguidesnewsletters.1997.NovDec01

   Abstract

   The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, provides useful definitions of employability, employability determination, and medical determinations related to employability. As the AMA Guides notes, and the term medical determination related to employability has supplanted the use of employability. Clearly, factors unrelated to health status affect both employability and its determination, but the physician's role is limited to providing useful medical information, culminating in a statement of risk to the employer. The physician's purview never includes a determination of employability, nor does it justify an opinion that an individual is or is not employable. Managers in human resources departments can clarify the basic principles of equal employment opportunity and thereby minimize the risk of intentional or inadvertent discriminatory actions. Disability evaluation covers the interplay of the injured employee, the human resources function, and the health care providers. When a worker's health status is a factor, the physician's assistance in helping an employer determine employability is crucial, but physicians must never voluntarily state that a person is or is not employable. Physicians can assist an employer in determining if a medical condition precludes travel to work, being at work for a specified time, and assignment of appropriate tasks with or without reasonable accommodation.
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2. Impairment Tutorial: The Challenge of Evaluating RSD Impairment and Disability (Part I)

   Leon H. Ensalada

   Pages 3–5

   DOI: 10.1001/amaguidesnewsletters.1997.NovDec02

   Abstract

   Reflex sympathetic dystrophy (RSD) refers to subjective complaints of pain associated with soft-tissue changes that may not be caused by sympathetic nervous system dysfunction and for which no reflex has been demonstrated. One definition indicates that RSD, like causalgia, is manifested by pain, allodynia, hyperalgesia, and hyperesthesia and, frequently, by vasomotor and sudomotor disturbances and skeletal muscle hypotonia. The diagnosis of RSD depends on the patient's response to regional sympathetic blockade but does not take into account the questionable validity of the sympathetic mediation hypothesis, the placebo effect, or inadequately performed regional sympathetic blockade. These confounders have contributed to the misdiagnosis and overdiagnosis of RSD and causalgia. Since the publication of the AMA Guides to the Evaluation of Permanent Impairment, Fourth Edition, the International Association for the Study of Pain has proposed a new term, complex regional pain syndrome (CRPS) that replaces RDS and causalgia. Dissenting views suggest that the criteria for RDS are vague or that patients with RSD are not a homogeneous population. Evaluators should eliminate alternative diagnoses and then base a finding of RSD, causalgia, or CRPS on a preponderance of clinical evidence. [Part 2 of this article in the next issue of The Guides Newsletter will address impairment due to RSD/causalgia/CRPS.]
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3. Clinical Update: Causality and Apportionment

   Henry J. Roth

   Pages 6–7

   DOI: 10.1001/amaguidesnewsletters.1997.NovDec03

   Abstract

   Assessing medical causality requires a clear understanding and discussion of causal relationships, and definitions of impairment may have special meaning in a legal context beyond their usual meanings in medical communications. In addition to assessing cause and effect and medical possibility vs medical probability, evaluating physicians must understand and carefully use terminology such as aggravation or exacerbation that have specific definitions and uses. Documentation of aggravation or causation depends on the acquisition, review, and analysis of medical documentation, including medical office and hospital records; available past medical records; results of tests or diagnostic procedures; results of permanent occupational or environmental surveys; medical information showing that an alleged factor could have caused or contributed to the effect; and occupational documentation of an alleged exposure or cause. Pitfalls during the assessments include the patient's aging, natural inherent limitations, self-abuse, and psychosocial factors that individually or collectively may confound medical causality and apportionment assessment. The evaluating physician alone is responsible for apportioning these factors and must provide the medical basis for all conclusions and opinions. Previous impairment of an organ system may be subtracted from the current impairment rating, and the written analysis should address separately a divergence between changes in impairment and disability.
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4. Literature Review

   Robert Haralson

   Pages 7–7

   DOI: 10.1001/amaguidesnewsletters.1997.NovDec04